Peak systolic velocity Doppler of middle cerebral artery in small for gestational age (SGA) fetus

Abstract

BACKGROUND: Small for gestational age (SGA) has high frequency which increases the risk of long-term adverse outcomes. Thus the aim of this study was to evaluate peak systolic velocity Doppler of middle cerebral artery (MCA) in SGA fetus in order to find appropriate method to diagnosis SGA sooner.

MATERIALS and METHODS: This prospective longitudinal study was conducted on 90 pregnant women with a diagnosis of SGA fetus and 90 pregnant women with normal fetus. Then MCA and umbilical artery assessment were performed for all subjects and compared between two groups.

RESULTS: Doppler assessment showed that umbilical artery PI was significantly higher in SGA group as compared to normal group (1.11±0.37 vs 0.98±0.18, P = 0.003), while MCA PI was significantly lower in SGA group (1.77±0.44 vs 1.92±0.47, P = 0.028). On the other hand, PSV did not differ between the groups (P = 0.592). Moreover, we found that PSV was more in SGA group by grouping maternal age (<27 years) (P = 0.006), and gestational age (>34 weeks) (P<0.001).

CONCLUSION: The results of this study suggest that MCA PI decreased significantly in SGA fetuses, while UA PI increased in this group. Moreover, PSV increased in this group when evaluated in different subgroups (based on maternal age and gestational age).

Keywords

small for gestational age / middle cerebral artery / peak systolic velocity

References

[1] Bahlmann F, Reinhard I, Krummenauer F, Neubert S, Macchiella D, Wellek S (2002). Blood flow velocity waveforms of the fetal middle cerebral artery in a normal population: reference values from 18 weeks to 42 weeks of gestation. J Perinat Med, 30(6): 490–501

[2] Cruz-Martinez R, Figueras F (2009). The role of Doppler and placental screening. Best Pract Res Clin Obstet Gynaecol, 23(6): 845–855

[3] Fong K W, Ohlsson A, Hannah M E, Grisaru S, Kingdom J, Cohen H, Ryan M, Windrim R, Foster G, Amankwah K, and the Fong KW1 (1999). Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries. Radiology, 213(3): 681–689

[4] Gardosi J, Kady S M, McGeown P, Francis A, Tonks A (2005). Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ, 331(7525): 1113–1117

[5] Hecher K, Bilardo C M, Stigter R H, Ville Y, Hackelöer B J, Kok H J, Senat M V, Visser G H A (2001). Monitoring of fetuses with intrauterine growth restriction: a longitudinal study. Ultrasound Obstet Gynecol, 18(6): 564–570

[6] Hernandez-Andrade E, Scheier M, Dezerega V, Carmo A, Nicolaides K H (2004). Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops. Ultrasound Obstet Gynecol, 23(5): 442–445

[7] Kassanos D, Siristatidis C, Vitoratos N, Salamalekis E, Creatsas G (2003). The clinical significance of Doppler findings in fetal middle cerebral artery during labor. Eur J Obstet Gynecol Reprod Biol, 109(1): 45–50

[8] Khanduri S, Parashari U C, Bashir S, Bhadury S, Bansal A (2013). Comparison of diagnostic efficacy of umbilical artery and middle cerebral artery waveform with color Doppler study for detection of intrauterine growth restriction. J Obstet Gynaecol India, 63(4): 249–255

[9] Lindqvist P G, Molin J (2005). Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol, 25(3): 258–264

[10] Lobmaier S M, Figueras F, Mercade I, Perello M, Peguero A, Crovetto F, Ortiz J U, Crispi F, Gratacós E (2014). Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late-pregnancy small-for- gestational-age fetuses. Ultrasound Obstet Gynecol, 43(5): 533–540

[11] Mari G, Deter R L, Mari G (1992). Middle cerebral artery flow velocity waveforms in normal and small-for-gestational-age fetuses. Am J Obstet Gynecol, 166(4): 1262–1270

[12] Mari G, Hanif F, Kruger M, Cosmi E, Santolaya-Forgas J, Treadwell M C, the Mari G1 (2007). Middle cerebral artery peak systolic velocity: a new Doppler parameter in the assessment of growth-restricted fetuses. Ultrasound Obstet Gynecol, 29(3): 310–316

[13] McCowan L M E, Roberts C T, Dekker G A, Taylor R S, Chan E H Y,Kenny L C , Baker P N, Moss-Morris R, Chappell L C, North R A, and the SCOPE consortium (2010). Risk factors for small-for-gestational-age infants by customised birthweight centiles: data from an international prospective cohort study. BJOG, 117(13): 1599–1607

[14] Nalini Y, Jyothirmayi K, Reddy C M (2015). Fetal outcome in relation with Colour Doppler study of middle cerebral artery & umblical artery in intrauterine growth restriction. IJRMS, 3(7): 20–31

[15] Nanthakomon T, Uerpairojkit B, the Nanthakomon T1 (2010). Outcome of small-for-gestational-age fetuses according to umbilical artery Doppler: is there any yield from additional middle cerebral artery Doppler? J Matern Fetal Neonatal Med, 23(8): 900–905

[16] PMMRC, and the Sixth Annual Report of the Perinatal and Maternal Mortality Review Committee Reporting mortality 2010.Wellington: Health Quality & Safety Commission; 2012.

[17] Roex A, Nikpoor P, van Eerd E, Hodyl N, Dekker G (2012). Serial plotting on customised fundal height charts results in doubling of the antenatal detection of small for gestational age fetuses in nulliparous women. Aust N Z J Obstet Gynaecol, 52(1): 78–82

[18] Ropacka-Lesiak MWewnątrzmaciczne ograniczenie wzrastania płodu. In: Bręborowicz GH. ed. Położnictwo Tom 2 Medycyna matczyno-pło-dowa. PZWL, Warszawa, Warszawa 2012: 105–117.

[19] Wright J, Morse K, Kody S, Francis A (2006). Audit of fundal height measurement plotted on customised growth charts. MIDIRS Midwifery Digest., 16(3): 341–345

Acknowledgments

This study was financially supported by Technology and Research Development Department of Jundishapur Medical Sciences University, Ahvaz, South-west Iran. We gratefully acknowledge the dedicated efforts of the investigators, the coordinators, and the Clinical Research Development Units (CRDU) of Ahvaz Imam Hospital.

Compliance with ethical standards

The authors declared no conflict of interest. All procedures have been approved by the appropriate ethics committee and have therefore been performed inaccordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was signed prior to participation in the study.

RIGHTS & PERMISSIONS

2018 Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature